In model simulations of peripheral arterial disease, combining ABI restoration with exercise training increased muscle perfusion to 80% of baseline, compared to 66% with ABI restoration alone.
Does restoring both microvascular structure and upstream input pressure improve skeletal muscle perfusion in a computational model of PAD?
Computational modeling demonstrates that restoring both upstream input pressure and microvascular structure (via exercise) is necessary to optimally improve muscle perfusion in peripheral arterial disease.
Absolute Event Rate: 80% vs 66%
OBJECTIVE: To estimate the relative influence of input pressure and arteriole rarefaction on gastrocnemius muscle perfusion in patients with PAD after exercise and/or percutaneous interventions. METHODS: A computational network model of the gastrocnemius muscle microcirculation was adapted to reflect rarefaction based on arteriolar density measurements from PAD patients, with and without exercise. A normalized input pressure was applied at the feeder artery to simulate both reduced and restored ABI in the PAD condition. RESULTS: In simulations of arteriolar rarefaction, resistance increased non-linearly with rarefaction, leading to a disproportionally large drop in perfusion. In addition, perfusion was less sensitive to changes in input pressure as the degree of rarefaction increased. Reduced arteriolar density was observed in PAD patients and improved 33.8% after three months of exercise. In model simulations of PAD, ABI restoration yielded perfusion recovery to only 66% of baseline. When exercise training was simulated by reducing rarefaction, ABI restoration increased perfusion to 80% of baseline. CONCLUSION: Microvascular resistance increases non-linearly with increasing arteriole rarefaction. Therefore, muscle perfusion becomes disproportionally less sensitive to ABI restoration as arteriole rarefaction increases. These results highlight the importance of restoring both microvascular structure and upstream input pressure in PAD therapy.
Heuslein et al. (Fri,) conducted a other in Peripheral Arterial Disease. Exercise training and ABI restoration (simulated) vs. ABI restoration alone (simulated) was evaluated on Gastrocnemius muscle perfusion recovery. In model simulations of peripheral arterial disease, combining ABI restoration with exercise training increased muscle perfusion to 80% of baseline, compared to 66% with ABI restoration alone.
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